Predictive Analysis About Conversion Of Laparoscopic Cholecystectomy To Open Surgery

Background and Objectives:In 1987,the french doctor Mouret P accomplished the first case of laparoscopic cholecystectomy.After 1989 laparoscopic surgery was very popular in the world.Chinese doctor accomplished the first case of laparoscopic cholecystectomy because of the upsurge in 1991.And in this year there were 14 hospitals developing the surgery of LC.Up to now LC has been the gold standard of operation on gallbladder.Comparing to the OC,LC has obvious merit of safety,wide visual field,little trauma,few hemorrhage,light pain,fast recovery and little scar.But ther are some LC cases having to turn to OC because of serious adherence in the Calot septa.According to the statistics data of 142946 LC cases the conversion rate was 2.1%.1685 LC cases was done in my hospital from 1/2002 to 1/2007 and the conversion rate was 2.5%.So how to predict the conversion to OC precisly is very important to raise the achievement ratio of LC. To establish the scoring system can solve the problem easily.According to this scoring system the doctors of different level can choose the different cases and they can communicate to the patients easily.And the severe complication can be avoided in the operation.So establishing scoring system is very important to raise achievement ratio and to reduce complication.This text is to establish a scoring system that predicts the probability of conversion of laparoscopic cholecystectomy(LC)to open cholecystectomy(OC) based on preoperative clinical data,evaluating the degree of operation difficulty and possibility of conversion about LC cases.Methods:Anivariable analysis was performed for the preoperative clinical data of the 42 LC cases conversing to OC and 200 LC cases selecting stochasticly in our hospital from 1/2002 to 1/2007.Then multivariable analysis with logistic regression was performed for the selected risk factors.Male,≥60 years old,atrophy of gallbladder(≦4.5cm*1.5cm),thickened wall of gallbladder(≥0.4cm),high level of total bilirubin(＞17.1umol/L),history of upper abdominal operation,diabetes and acute cholecystitis were risk factors and given scores respectively.Thus the scoring system was established.The comprehensive scores were calculated for all the 242 cases.The conversion rates of different score groups were compared.The scoring system was evaluated with ROC curve.Results:1.Male,≥60 years old,atrophy of gallbladder(≦4.5cm*1.5cm),thickened wall of gallbladder(≥0.4cm),high level of total bilirubin(＞17.1umol/L),history of upper abdominal operation,diabetes and acute cholecystitis were risk factors of conversion of LC to OC.2.For the 242 cases,the higherscore a group had,the higher conversion rate it had.The conversion rates of most adjoining groups had significantly statistical difference(P＜0.01).3.The area below ROC curve was 0.899.The most ideal fraction is 63.Its sensitivity and specificity are 0.881 and 0.715.The conversion rate is 14.59%below 63 and it is 88.89%above 63,having statistical difference(P＜0.001).Conclusion: The probability of conversion of LC to OC can be predicted based on risk factors to guide clinical practice.